Monday, August 31, 2009

The New York Times Magazine reported the brutal conditions Memorial Medical Center staff faced in the aftermath of Hurricane Katrina. The story focused on medical care, specifically on allegations of euthanasia of acutely ill patients.

Forty five patient corpses were removed from MMC, ten of which expired before Katrina struck. The report suggested over half received medication hastening their death. Of the 35 deaths, 25 occurred on the LifeCare unit, which rented a floor in Memorial. Their mortality rate after Katrina was 48%. Tenet Health owned Memorial Medical Center had 10 deaths.

The NYT story didn't mention several items:

1. The Carlyle Group purchased LifeCare Hospitals just weeks before landfall. The deal closed August 11, 2005. Katrina struck the Gulf Coast on Monday, August 29.

At LifeCare that afternoon (Tuesday, August 30), confusion reigned. The company had its own “incident commander,” Diane Robichaux, an assistant administrator who was seven months pregnant. At first everything seemed fine; Robichaux established computer communications with LifeCare’s corporate offices in Texas and was assured that LifeCare patients would be included in any FEMA evacuation of Memorial. But as the day wore on, the texts between LifeCare staff members and headquarters grew frantic as it became clear that the government’s rescue efforts and communications were in chaos.

Surely LifeCare headquarters in Dallas apprised their new owners of their struggling Memorial unit. What help did they request from the politically connected Carlyle Group? Who did Carlyle leaders call in the Bush White House?

2. LifeCare sued Tenet as a result of damages from the storm. Damages arose from loss of power and lengthy delays in evacuation. Tenet settled the LifeCare suit, but their confidential settlement is sealed from public view. Tenet eventually hired medical evacuation helicopters, in an HCA like move:

Soon after sunrise on Thursday, Sept. 1 — more than 72 hours into the crisis — Memorial’s chief financial officer, Curtis Dosch, delivered good news to hospital staff gathered on the emergency-room ramp. He had reached a Tenet representative in Dallas and was told that Tenet was dispatching a fleet of privately hired helicopters that day.

3. LifeCare's defense (in wrongful patient death suits) states patients became wards of the federal government when FEMA evacuation teams arrived in New Orleans. This is patently laughable, but it serves as a defense for ceasing patient treatment, stopping IV's needed to keep patients hydrated. Yet, patients received non-indicated pain medications.

The (Memorial) administrator told him that the hospital was in survival mode, not treating mode. Furious, Mark LeBlanc (relative of LifeCare patient) asked, “Do you just flip a switch and you’re not a hospital anymore?”

After several helicopters arrived and rescued some of the LifeCare patients, Air Force One flew over New Orleans while President Bush surveyed the devastation. Few helicopters arrived after that.

Helicopters were available, just not ordered to help by Defense Secretary Rumsfeld.

5. A year after the report was released, Tenet (also with no mention in the LL report) appointed Jeb Bush to its Board of Directors. However, MMC's political links have a bipartisan flavor.

6. Accrediting bodies required Memorial and LifeCare to have comprehensive disaster plans, including evacuation components. The Lessons Learned report sparsely refers to triage and patient evacuations. It doesn't clarify methods used or evaluate performance. This abdication helps LifeCare/Memorial, which flipped the normal triage method of evacuating seriously ill patients first. Industry and government have not come to grips with appropriate evacuation or triage methods.

Typically, medical workers try to divvy up care to achieve the greatest good for the greatest number of people. There is an ongoing debate about how to do this and what the “greatest good” means. Is it the number of lives saved? Years of life saved? Best “quality” years of life saved? Or something else?

Pou has also been advising state and national medical organizations on disaster preparedness and legal reform; she has lectured on medicine and ethics at national conferences and addressed military medical trainees. In her advocacy, she argues for changing the standards of medical care in emergencies. She has said that informed consent is impossible during disasters and that doctors need to be able to evacuate the sickest or most severely injured patients last — along with those who have Do Not Resuscitate orders — an approach that she and her colleagues used as conditions worsened after Katrina.

If Dr. Pou's method becomes the new standard, does that help the Carlyle affiliate's defense?

7. LifeCare's obligation to patients did not end when power failed on the seventh floor. LifeCare credentialed physicians and hired competent clinical staff to care for its patients. It's hard to believe an ENT doctor, Dr. Anna Pou, was LifeCare's chief clinician. LifeCare clearly had a duty to keep Memorial doctors and nurses with questionable motives away from its patients.

8. The NYT story implies political influence from prosecutors in the grand jury. LifeCare went from zero lobbying dollars in 2005 to $560,000 in 2006. Did it fund calls to the New Orleans prosecutor, who allowed a grand jury to select what evidence they wished to hear? How much was spent to influence the President's Lessons Learned report? It couldn't function better as a risk management document for Carlyle's newest affiliate or Tenet Health.

Tenet spent over $1.3 million on lobbying in 2005 & 2006. Landrieu Public Relations, a New Orleans based firm with strong local connections, received roughly $200,000 to lobby the House and Senate. The Stafford Act was the main topic. It's the law that allows FEMA to respond to disasters. Did Phyllis Landrieu speak with Rep. Rahm Emanuel, once mentored by the CEO of GTCR Golder Rauner? GTCR sold LifeCare Hospitals to Carlyle just weeks before landfall.

A different lobbying firm, Quinn Gillespie & Associates, discussed corporate governance changes with the Executive Office of the President in early 2006. In less than a year, President Bush's brother Jeb was named to the Tenet Board. Did George W. trade a report omission for a board position?

9. Robby Dubois and Earl Reed ceased employment with LifeCare/Carlyle. Ms. Dubois attributed Katrina stress as her reason. Mr. Reed was the man in charge in Dallas. He could fill in the organizational side of the Memorial debacle, should he testify. However, odds are high that Carlyle purchased his silence.

10. Fran Townsend, author of the hapless Katrina investigation, landed a job with Baker Botts. She heads up their risk management consulting division. The dough boy in Baker Botts is James A. Baker, III, long connected to the Carlyle Group. Was Fran rewarded for minimizing LifeCare's exposure in her Lessons Learned report? On that sole parameter, she excelled.

We are currently defending ourselves against a variety of Hurricane Katrina related lawsuits or matters under review by the Louisiana Patient Compensation Fund. We are vigorously defending ourselves in these lawsuits, however, we cannot predict the ultimate resolution of these matters.

We maintained $15.0 million of general and professional liability insurance during this period, subject to a $1.0 million per claim retention. We believe that under our insurance policies, only one retention is applicable to the Hurricane Katrina matters since these matters all arose from a single event, process or condition.

Our insurance carriers are currently paying all costs related to these claims, but have sent reservation of rights letters which challenge, among other things, the application of one retention to the Hurricane Katrina related matters. To the extent it is ultimately determined that a separate retention applies to each of these claims, we could experience significant losses related to these Hurricane Katrina matters which would negatively impact our financial position, liquidity and results of operations.

Carlyle leaders hate a level playing field. Their good name was not mentioned in the NYT piece. Carlyle Managing Director William Kennard sits on the board of the New York Times. Did that have any impact on any still untold aspects of the Carlyle-Tenet-Bush Katrina debacle?

Having evacuated a Texas Gulf Coast 165 bed hospital before a record hurricane and endured in a flooded, 725 bed Virginia teaching hospital, LifeCare's legal defenses are a canard. Funny, that sounds like Kennard.

(The LifeCare case in the last link is on page 35 of the document.)

Update 3-29-14: The hellish five days before rescue are chronicled in a book, Five Days at Memorial by Sheri Fink. I am grateful someone investigated the events at Memorial. I'd love to know what happened at the White House and what actions Carlyle officials took, both during and after the storm. I'd also like to know the events precipitating Jeb Bush's appointment to the Tenet Healthcare Board, given Tenet owned Memorial Medical Center when Katrina make landfall.

Thursday, August 27, 2009

The funeral for Elmer Kelton will be held today. He was a Charter Member of the San Angelo Writers' Club. A small group met yesterday evening at Johnson's Funeral home. Rev. Travis Monday and Rev. Monte Jones prayed, as the group held hands. Ross McSwain noted the powerful role Kelton played in his life, part father, part brother.

The SAWC is collecting memories of Elmer. Judie Oberheuser will compile them in our upcoming newsletter. My contribution is below:

As VP-Programs I nervously called Mr. Kelton about doing a program for the club. Elmer said “I’ve been meaning to speak to that group for a while." By the time I hung up, the call seemed like his idea. He graciously treated us to a preview of Sandhills Boy. Elmer Kelton, such a fine gentleman and talented writer.

Dr. Preston Darby had this to say about his friend and former patient:

“There’s no one I’d rather talk about than Elmer Kelton,” said a smiling Preston Darby. “He epitomized niceness.” Dr. Darby should know. Mr. Kelton was his teacher and patient.

Pres Darby became the student in 1997, taking Elmer Kelton’s course at Angelo State University. His classmates included Ross McSwain, Kevin Barry, and Fazlur Rahman. Pres admits he might have been the least experienced writer in the room. Yet, his awful short story produced his most prized possession. Darby said, “I got back a one page critique signed by the greatest Western writer of all time. Who has that? He said it was bad, but Elmer was so gracious in his criticism.”

Mr. Kelton was careful to read aloud student’s work without attributing the author. He read Darby’s subsequent short story to the class. Elmer stated, “The only suggestion I have is this be submitted for immediate publication.” Dr. Darby said he was sure his head swelled, so much so, that it filled the room.

The good friends loved to tell stories that involved each other. Dr. Darby recalled the day Elmer came to his office, looking ashen. An EKG showed Kelton having a heart attack. A call to the ICU revealed no available beds. Pres finagled one. He didn’t want to be the physician responsible for losing West Texas’ treasure. “Otherwise, I’d have to move to the moon, so many people would’ve been after me,” quipped Darby.

Pres said Elmer frequently returned the favor. Kelton told of readying to go home from a hospital stay, when Dr. Darby showed up with several books to autograph for his daughter. After the author signed, Pres said, “Thank you, Elmer, now I’ll take my foot off your oxygen hose.” If Elmer Kelton felt any pressure, the public had few signs.

Dr. Darby fondly recalled his last visit from Mr. Kelton, New Year’s Day 2009. Pres said, “Who visits on New Year’s Day? Most people are hung over. Not Elmer. He took time to spend with me. It helped my spirits. His visit gave me a burst of stubbornness to hang on for a while.”

When asked what they talked about, Pres noted books, travels, & family. “I told him I knew he had more books in him. It was a delightful visit. Elmer could talk to a stick and enjoy making it feel welcome. He typified the word ‘gentleman.’ Elmer’s the best person I’ve known. We’re losing civil discourse as a society. I can’t think of a better role model.”

Darby shared a few writing tips that Kelton offered:

1. If you ever write a book and have a character you don’t know what to do with, kill him.2. On writing dialects: It’s like seasoning on a stew. A little improves it. Too much ruins the whole batch.3. On using harsh language: It’s your character speaking, not you. If he’s despicable, he’d speak despicably. Once again, don’t overdo it. A little goes a long way.4. Never write a book you don’t want your grandchildren reading.

Dr. Darby said Elmer’s class was the best class he’s taken, adding “it surely was the most enjoyable.” He summed up his relationship with Mr. Kelton. “Millions have known him by his stories, writings and presentations, I’ve known him as a professor, as my patient and my friend. Elmer’s gone. He was the Pope of niceness. We lost a lot.”

How will the 55 million get health insurance? Some will qualify for Medicaid, but 85% will need to shop for a plan. Unions badly wish to be relevant again. They want to serve as an intermediary, offering group health insurance to members. The employee pays more, with the government providing some subsidy in many cases.

Unions will need rapid access to workplaces to backfill the employer coverage sinkhole. Thus, the call for card check. Health reform and card check are paired together in Congress for a reason.

Monday, August 24, 2009

The bill, approved by a House committee late last month, includes Section 164, a reinsurance program for retirees, according to a summary of the bill from House Speaker Nancy Pelosi's office. It sets aside $10 billion to establish a temporary reinsurance program to provide reimbursement to participating employment-based plans for part of the cost of providing health benefits to retirees age 55-64 and their families. A Senate version has nearly identical language.

This $10 billion subsidy goes to employer or union programs, i.e. it helps people that already have insurance.

Employment-based plans must apply to participate and be approved, and the health care plan would reimburse participating employment-based plans for 80 percent of the cost of benefits in excess of $15,000 and under $90,000. The plans are required to use the funds to lower costs borne directly by participants and beneficiaries.

The government would 80% insure the employee and their family for care between $15,000 and $90,000. The employer or union would provide 20% of the coverage. Why the giveaway to those currently providing coverage? Corporations and unions provide huge campaign donations. Corporations want to dump that pesky health insurance benefit, while unions want to pick it up.

The provision would benefit a "wide range of retiree health care plans, including those sponsored by large private-sector employers, by state and local governments, and by VEBAs (union) ," according to Bloomberg News, which reported the provision Friday.

I thought health care reform was to cover the uninsured and bend the cost curve. This subsidy is another federal giveaway, benefiting the usual suspects. It fits with the Stimulus provision providing $25 billion in tax breaks to corporations buying back debt on the cheap.

Saturday, August 22, 2009

A white collar criminal was renditioned from Afghanistan to a Washington suburb. It is the first known renditioning under the Obama administration. The Lebanese man, Raymond Azar, worked for Sima Salazar Group. The firm was awarded more than $50 million in Pentagon contracts for work in Afghanistan.

Military contractors offered bribes to two Army Corp of Engineer officials, one in Kabul and another in the U.S. Sima Salazar was one of the firms offering bribes. Consider Mr. Azar's treatment, as reported by the LA Times:

In court papers, Azar said he was denied his eyeglasses, not given food for 30 hours and put in a freezing room after his arrest by "more than 10 men wearing flak jackets and carrying military style assault rifles."

Azar also said he was shackled and forced to wear a blindfold, dark hood and earphones for up to 18 hours on a Gulfstream V jet that flew him from Bagram air base, outside Kabul, to Virginia.

Before the hood was put on, he said, one of his captors waved a photo of Azar's wife and four children and warned Azar that he would "never see them again" unless he confessed.

"Frightened for his immediate safety . . . and under the belief he would end up in the prison camp at Guantanamo Bay or Abu Ghraib to be tortured," Azar signed a paper he did not understand, his lawyers told the court.

Prosecutors, however, said that Azar was "treated professionally," kept in a heated room, offered food and water repeatedly and "provided with comfortable chairs to sit in."

They said he was photographed naked and subjected to a cavity search to ensure that he did not carry hidden weapons and was fit for travel. Court records confirmed that Azar was shackled at the ankles, waist and wrists and made to wear a blindfold, hood and earphones aboard the plane.

And the reason for treating the white collar criminal like a terrorist?

As the Obama administration steps up efforts to curb fraud at military facilities in Iraq and Afghanistan, a senior Army official said Azar's case "should serve as a warning" to other contractors.

Since rendition "works," the Obama administration used it to demotivate other fraudulent actors. What about other methods employed in the war on terror? Take summary execution by drone fired missile. Should intrepid bloggers worry about a red laser dot on their basement window?

How about torture? Instead of Tasing Granny roadside, will she have to stand on a box on one leg, holding wires? How many "working policies" will be employed domestically? Surely, others need a warning.

P.S. Now that the Carlyle Group is out of the nightmarish renditioning business, via their sale of Landmark Aviation (along with Standard Aero), did Dubai Aerospace conduct the flight? Change for the money changers.

Friday, August 21, 2009

Ex-White House Homeland Security Adviser Frances Townsend bristled at Tom Ridge's assertion that political pressure was applied to increase the threat level during the 2004 elections. The Boston Globereported:

Frances Townsend, said yesterday that politics never played a role in determining alert levels.

Note Fran's focus on "the facts."

She noted that in the weeks leading up to the election two videotapes were released by al Qaeda, including one by terrorist leader Osama bin Laden, that she said contained “very graphic’’ and threatening messages.

"Politics" never played a role in Homeland Security is pure hyperbole, coming from the author of the White House Lessons Learned report. Frances omitted the hospital with the highest patient death toll. Memorial Medical Center lost 35 patients after Hurricane Katrina. This warrantednot one mention in Mrs. Townsend's tome.

Her omissionbenefitedtwo hospital companies, Tenet Health and LifeCare Hospitals. The Carlyle Group, a politically connected private equity underwriter (PEU) purchased LifeCare just weeks before Katrina sideswiped New Orleans. Back to her defense of the Bush White House:

Townsend said that any time there was a discussion of changing the alert level, she first spoke with Ridge and then, if necessary, called a meeting of the homeland security council. The group then made a recommendation to the president about whether the color-coded threat level should be raised.

Asked if there was any reason for Ridge to have felt pressured, Townsend said: “He was certainly not pressured. And, by the way, he didn’t object when it was raised, and he certainly didn’t object when it wasn’t raised.’’

Resigning one's job isn't a form of objection? The good news is Mrs. Townsend landed a risk management consulting job with Baker Botts. She did so after managing the risk for James A. Baker's buddies at the Carlyle Group. Big money shepherds the loyal. Fran earned a planeload of frequent liar points with her Ridge discount. Look for more of her commentary on CNN.

Recall the Washington Post flier hawking access to top Obama White House advisers for $25,000? The blond on the left (with her hand around a glass) is Elizabeth Baker Keffer. She's in the same business for the Atlantic. The woman in the middle is Tammy Haddad.

“We went over backwards repeatedly and with great discipline to make sure politics did not influence any national security and homeland security decisions,” former White House chief of staff Andy Card told POLITICO. “The clear instructions were to make sure politics never influenced anything.”

Thursday, August 20, 2009

President Obama stated the freed Pan Am Flight 103 bomber should be placed under house arrest and not be given a hero's welcome. I assume this covers not getting VIP treatment at Col. Gahdafi's ranch, like Senator John McCain (R-AZ). McCain tweeted from Libya last Friday. Was he there negotiating something, like a prisoner's release (a la George H.W. Bush/Ronald Reagan in Iran-1980)? Apparently not.

Does Obama's request preclude the bomber's working as a Libyan lobbyist for President Gahdafi? Can he attend dinners sponsored by politically connected, private equity underwriters (PEU's) like the Carlyle Group? They have $500 million to invest in the Middle East/North Africa and their co-founders hate a level playing field. Is the bomber's release a chess piece in their tilted game?

Does Mrs. Cohen have it right?

"I think it's appalling, disgusting and so sickening I can hardly find words to describe it," said Susan Cohen, of Cape May Court House, New Jersey, whose 20-year-old daughter, Theodora, died in the attack. "This isn't about compassionate release. This is part of give-Gadhafi-what-he-wants-so-we-can-have-the-oil."

Wednesday, August 19, 2009

Now "change" means," no change from W." The Blue playbook is a carbon copy of the Red's. Jane Hamsher of FireDogLake said on the Rachel Maddow Show:

It became clear Rahm Emanuel and Max Baucus were trying to deal a public plan away to the AMA, the hospitals, pharma in exchange for keeping the money out of Republican coffers for 2010.

For-profiteer White House Health Czar Nancy-Ann DeParle negotiated back room deals with her former colleagues, proprietary health care companies. Big insurers get a legal requirement for citizens to purchase health insurance, while employers continue to shed the benefit to workers.

Democratic projections call for 122 million to be covered by employers under the Obama plan. 177 million had employer sponsored insurance in 2007. That's a drop of 55 million in workplace coverage.

Who stands ready to pick up the slack of 101 million people, 46 million uninsured plus the 55 million losing employer coverage, ? A tapped out Uncle Sam will pick up less than one quarter, 23.7 million. It plans to expand Medicaid (15 million) and subsidize a public plan (8.7 million).

Who will cover the remaining 77 million? Unions badly want to become relevant by serving as a group health insurance aggregator. Think it's coincidence that health reform and the Employee Free Choice Act are considered in the same session?

AFL-CIO Chief said the public option is "do or die" for unions. Who throws their body on a stake for nonunion members? Unions see the 55 million as ripe for recruitment, with group health insurance as the carrot. Thus the need for card check. Think I'm nuts? SEIU President Andy Stern said two years ago:

"We have to recognize that employer-based health care is ending. It's dying. It will not return."

I expected the head of a health care union to be the last to cave, not one of the first. With the benefit dump, unions would manage billions in retirement and health care benefits. They'd be the mirror image of their stated nemesis, private equity underwriters (PEU's) like The Carlyle Group. I want America's elected leaders and their staffers working on the public's behalf, not unions and/or PEU's.

Some final observations, health reform has billions going for comparative effectiveness research. Uncle Sam will pay insurance companies to mine and market their databases for clinical effectiveness. Just as "No Child Left Behind" stuffed the pockets of educational testing companies, comparative effectiveness will line the pockets of big insurers.

Back to the red/blue split, Republicans know their campaign cash is at risk. Thus, things are getting nasty. David Axelrod's old firm benefited from huge ad buys. Politicoreported:

The coalitions are a strange-bedfellows mix of business, labor and health care groups including the Pharmaceutical Research and Manufacturers of America (better known as PhRMA), the American Medical Association, the Service Employees International Union and the liberal group FamiliesUSA.

If benefactors make the blue & red boys play nice, major shifts are coming. Sponsors ponied up big to come out on top. It's time to take the money out of politics. Until that point, I plan to vote "none of the above."

Tuesday, August 18, 2009

The insurance industry is a big sponsor of the six Senators comprising the Gang of Six. The bipartisan group works to craft a health care reform bill in the Senate Finance Committee. Their lifetime donations from the insurance industry are roughly (insurance industry rank is in parenthesis):

Monday, August 17, 2009

A leading liberal blogger encouraged everyone to tell their friends about the above flowchart on health reform. What Matt Yglesias didn't say is how it compares to the latest Census data on the insured and uninsured.

Employers provided coverage for 177.4 million people in 2007, over 55 million more than the 122 million projected in the chart. That would be a 31% drop in employer based coverage.

Medicaid covered 39.6 million in 2007. Adding the 23% uninsured who are Medicaid eligible drives drives the number up 10.5 million, to 50 million. Medicare covered 41.4 million in 2007 and that number is projected to grow with America's aging baby boomers. That's over 91.4 million combined, substantially greater than the 78 million projected for Medicare/Medicaid in the chart.

The last two boxes on the right total 99.5 million, with 72 million garnering some form of subsidy. Only 10%, or 7.2 million, are projected to be in the public option. The latest government data shows 45.7 million uninsured, although estimates peg the figure around 51 million.

This chart shows huge swings in who's paying for coverage, completely missed by Matt. I surmised health care reform was a ruse to allow employers to bail on that pesky health insurance benefit. I thought a tapped out federal government would have difficulty picking up the tab. Little did I know, it won't cover those who currently qualify.

The flowchart drives home my points. All signs point to the individual shouldering a greater burden. Is it a pundit data error or the plan?

New Census numbers will be out September 10 (about three weeks later than prior years). When did Max Baucus promise to have a bill ready? September 15, or later. Things will heat up...

"The fact of the matter is there are not the votes in the United States Senate for a public option. There never have been."

So President Barack Obama and the White House punked us? Where's the hidden camera? Everybody give out a big chuckle at our foolishness.

Looking back, the laugh is on us. Who could believe a filibuster-proof Democratic majority would ensure the government provide a quality service to people long disdained by the private sector? Not "Fox in the Henhouse" Kent Conrad or his many partners in corporate benefacting. Recall how quickly the White House coopted the "nonprofit plan" language and how vociferously Rahm Emanuel defended Blue Corporacrats from accountability.

Corporafornication is truly bipartisan and it took very little time:

June 11-Kent Conrad introduces co-op idea after meeting with UnitedHealth President Steve Hemsley

June 24-White House shifts language to accomodate a "nonprofit" public plan

August 7-White House warns groups not to run ads against Democratic Senators opposing a government run public plan

August 16-Kent Conrad delivers blistering discount of government run option's prospects in Senate. White House caves.

Sunday, August 16, 2009

Concho Valley health care providers see patients from a huge geographic area. It happens to have large numbers of uninsured people, from 23% to over 40% of various county populations. The U.S. Census Bureau estimates:

Representative Mike Conaway (R-TX) held a health care open house. He failed to mention the staggering rates of uncovered residents in the Concho Valley. His handout indicated nearly one quarter of the uninsured qualify for Medicaid, government insurance for low income citizens. The obvious solution? Mass enroll the Medicaid eligible, 23% of those without coverage.

"Implied Medicaid Expansion" Conaway counts on the public having a short memory. Not long ago, Mike railed against expanding Medicaid with a faulty income qualification level. Rep. Conaway has done virtually nothing to address the problem.

How determined is he to keep up this record? Consider his questioning of Dr. Christina Romer, Chair of the President's Council of Economic Advisers. The House Budget Committee meeting occurred on June 19. Mike made the following statement:

REP. CONAWAY: Well, far be it for me to make a political suggestion to the White House, and I know you do empirical work and analytical work, you're not into politics, but I do think that it's very -- (inaudible) -- that we not allow people who only want to focus on a number in terms of health care reform to ignore the other number, the cost of doing nothing. And I urge you to come up with a number that reminds the American people of what that would be if we in fact do not have health care reform.

"Do Nothing" Mike serves Texas. It has long held the top one or two spots in the nation for the uninsured. How might it react to a major expansion of Medicaid? The Texas Hospital Associationposition paper on health reform provides insight. It cites:

The limited ability of Texas to finance federally required expansions of the state’s Medicaidprogram

THA's Dr. Dan Stultz suggests Texas is not ready to play with Rep. Conaway's implied solution. This is the same State of Texas that tampered with Children's Health Insurance, sending hundreds of thousands of kids off the roles. How did that play out locally? All data is for Tom Green County. It reveals the number of children enrolled as of September each year.

Despite growing numbers of uninsureds, the number of CHIP covered kids is less than 2002-2003. What happened with other programs intended to provide care for the poor and near poor? Tom Green County Indigent Care behaved like State CHIP. The average annual spending for the period specified is:

1998-2000 $1,709,085 (This includes $417,591 in annual state subsidy)2001-2003-- $923,374

Three year savings amounted to $1.7 million. They continued to grow for the next four years, reaching a total $5 million. One might expect these savings to result in a higher income qualification than "dirtiest of the dirt poor." It didn't. That's a nice windfall for the County's reserves.

During this time, Judge Mike Brown advocated to the Texas Legislature that indigent care should not be a county responsibility. The judge felt it a federal responsibility, one that should be shouldered by Medicaid.

Is anyone confused as to who is responsible, federal, state or local officials? It's similar to the burn one gets when trying to resolve a computer technical problem. The software maker blames the hardware people and visa versa. Usually, people get angry or they give up. It's your choice. Just remember it at the ballot box, should you go. Remember Mike Conaway, the Odessa-Permain football player who failed to suit up, much less "tackle" health care.

Friday, August 14, 2009

Health care reform is portrayed as an ambulance rushing to an Emergency Room. It's not clear if the hospital is nonprofit, for-profit or government owned.

Assume the ambulance is on the way to a safety net hospital, one that serves all regardless of insurance status. What if the blocking drivers want the ambulance to change course, driving business to a for-profit facility? Who might they be?

Video enhancing technology enabled the identification of the foot draggers. It turns out the commercial was shot in Washington, DC, in close proximity to America's corporate sponsored Congress.

Senator Max Baucus has his foot firmly on the public option brake. Through his radio Dirty Max demands the ambulance driver accept co-ops as a substitute. Other "moderate" democrats press in on the emergency vehicle as the EMT considers his options. They include:

In an interview with WaPo's Ezra Klein, White House Health Czar Nancy-Ann DeParle showed her private sector health care roots. Nancy spent the last eight years as a private equity underwriter for CCMP Capital Partners and served on the boards of nine health related companies. Here's how it went:

Ezra: There's been a lot of talk lately about this deal with the pharmaceutical industry. Want to set the record straight on that?

Nancy-Ann: We had proposed as part of our budget around $95 billion from our industry. They came forward and after some negotiations, said $80 billion is a number we can support.

She referred to the deal with big Pharma as “our industry” and "we can support." Slip of the tongue or the result of a decade as a for-profiteer? Likely the latter, with her boss' support.

Day-to-day operations of the National Republican Congressional Committee are overseen by an Executive Director, who manages a staff of professionals with expertise in campaign strategy development, planning and management, research, communications, fundraising, administration, and legal compliance.

The NRCC employed Chief Financial Officer Chris Ward and assistant Cindy Hampton. Chris Ward embezzled upwards of $1 million in donations. He did so by fabricating audits and writing one signature checks to sham companies. No external auditor set foot in NRCC offices for five years. One might expect an Assistant Treasurer to note such an absence. The question is how long Cindy worked for sticky fingers Chris and how many non-audit periods were involved.

I'm sure the FBI is on top of it, as they investigate the year and a half old case. Funny, a web search shows no charges have been brought against Mr. Ward for embezzlement. Has an undisclosed settlement been reached, one that would save the Party of Pristine Morality further humiliation?

After Cindy left Chris Ward's den of financial obfuscation, Ms. Hampton worked for Senator John Ensign. An affair began, which turned into requests for hush money. A Christian counselor and fellow senator estimated it could take $1 million to make his pants-less shenanigans disappear. Who knew two people in the NRCC Treasurer's office could make lottery like gains off their inattentive or overly amorous bosses?

Wednesday, August 12, 2009

Representative Mike Conaway (R-TX) holds a health care open house today at Angelo State University. I have five questions and won't get to ask them all. They are:

1. The Odessa American quoted you as saying Republicans did "a lot," including introducing health savings account plans in 2004. Yet, the number of people without health insurance rose 2.2 million after the introduction of HSA's. The uninsured rose from 44.8 million in 2005 to 47 million in 2006.

Employer sponsored health coverage declined from 60.2 % of Americans in 2005 to 59.3% in 2007. The decade long decline in employer coverage continues.

Census Bureau statistics show the percent of uninsured in Tom Green County as 23% in 2006. It ranged from 28% to 40% in surrounding counties.

Data from a GAO study on health savings accounts revealed:

51% of people with HSA's make $75,000 or more vs. 18% of the general population55% of HSA eligible plan enrollees contribute to their health savings account, while 45% do not. This leaves 45% potentially underinsured.

How did allowing people to effectively self insure, for first dollars paid using tax free money, help people in West Texas? What data do you have that shows the impact of high deductible health plans and funded health savings accounts in the Concho Valley?

2. Given your past misrepresentations on health care issues, like income levels for Medicaid expansion, and campaign donations from health insurance PAC's, like WellPoint and Humana, why should someone in the health field believe your current assertions on health care reform?

3. What have you done to help constituents in the Concho Valley get access to affordable health insurance and affordable health care during your terms in office? The Tom Green County Indigent Health program spends a fraction of its budgeted resources. In the late 1990's and early 2000's it spent it all and more, going to the state for subsidies. Our local community health center lost a sizeable chunk of its federal 330 grant funding. Only Obama stimulus money, which you voted against, provided a significant, but temporary back fill. As the uninsured problem likely grew due to the deep recession, Tom Green County experienced a deleveraging of health care resources for the indigent and uninsured. What do you plan to do to change this situation and mobilize resources on behalf of citizens?

4. Why are leaders in both parties misrepresenting health care reform? President Obama raises the 14,000 a day losing coverage as a critical motivator, when new coverage doesn't go into effect until 2013. Republicans talk about death squads in reference to living wills, a twenty year old practice of patient determination in health care treatment. Why are Republicans and Democrats trying to fool the public?

5. America suffered through managed care and capitation in the 1990's. They went away because patients didn't like the plan restrictions and providers resented heavy handed utilization measures. Why refresh them as accountable care organizations and global payment. Shannon created their vertically integrated health care system in response. Since then, they dismantled key divisions. Community Medical Center sold out to HCA as it had no strategy for managed care.

The latest round of for-profit deals, KKR's purchase of HCA and CHS's buyout of Triad Hospitals, added $2 billion in interest expense to the nation's health care system. No new hospital was built, no new doctor added or high tech diagnostic or treatment device installed. Companies changed hands and the bill increased $2 billion. What do you plan to do to rein this in?

Note: Given the long line of upset people, I chose not to ask any. The list has been e-mailed to Conaway's office. Should he reply, I'll post it.

Update: 10-2-09 No reply from Representative Conaway's office. The San Angelo Standard Times did not fact check the numerous assertions made by the Congressman or his constituents.

Tuesday, August 11, 2009

Hospital list prices soared the last two decades. They're to the point that they are meaningless, except to the handful of private pay patients hospitalized for care. The New York Timesreported:

A patient in Illinois was charged $12,712 for cataract surgery. Medicare pays $675 for the same procedure. In California, a patient was charged $20,120 for a knee operation that Medicare pays $584 for. And a New Jersey patient was charged $72,000 for a spinal fusion procedure that Medicare covers for $1,629.

How did this happen? Hospitals have fixed price contracts with insurers like Medicare, Medicaid and private insurers. They pay based on DRG's, a per diem, discounted fee for service or a capitated amount. The only people getting bills with full charges are the uninsured and those wealthy enough to go bare (as in self insured). That's a relatively small percentage of hospital visits for non-safety net facilities.

Imagine riding a bicycle where only 10% of your pedaling goes into increased speed. Now, you have to keep up with Lance Armstrong. How fast do you have to spin? Your legs would be a blur.

Twenty years of health care cost increases are Lance Armstrong. Health care costs turned into a gazillion RPM's, as price increases only applied to a small percent of patients. Compound high percentage price raises over two decades and charges get ridiculous. However, it is a predictable result of America's non-healthcare system.

The situation is so irrational, said Uwe E. Reinhardt, a health economist at Princeton, that it simply cannot go on. “We will not emerge out of this decade with this lunacy,” Dr. Reinhardt said, adding, “You worry about credit card charges, you scream for consumer protection — why not scream for it here?”

Facing the influx of retired baby boomers and a lagging economy, the Social Security Admin. reported that their costs will exceed tax revenues in 2016, and the trust funds to allocate benefits will be exhausted in 2037. White House Economic Advisor Larry Summers goes over these and other issues threatening retirement security at the 11th Annual Retirement Research Conference.

I caught a portion of his remarks. He said policy makers were shifting to a target savings rate as a key measure. He forecast the decade (from now) will be the most influential since the 1930's.

In the Q & A he addressed defined benefit plans vs. defined contribution plans. Defined benefit plans are rare, with most employers having switched to non-pension retirement benefits, 401(k)'s and 403(b)'s. Many eliminated the corporate match, leaving employees alone in funding their non-Social Security retirement.

Is it coincidence that Larry Summers talked about retirement the day after the Bipartisan Policy Council called for immediate reform to Medicare and Social Security?

When Larry Summers went off, CSPAN shifted to President Barack Obama's health care town hall meeting. Employers want to do to health insurance what they did to defined benefit pension benefits, shift the burden to the individual.

Corporacrats in the White House and Congress will grease the skids for this shift. Health insurance will be dumped to the individual faster than the two decade long period of the defined benefit pension dump. It might happen in the pivotal decade highlighted by Mr. Summers.

America needs a "savings rate" for the individual to shoulder the numerous future burdens. Corporations and their elected lackeys will not do so transparently.

"... creating a commission, outside Congress, empowered to make recommendations on a global solution to deficits, including tax reforms, entitlement changes, and new ways of measuring and controlling government finances, and compel Congressional Action on such recommendations. It urges immediate reform to Medicare and Social Security in order to bring solvency to those systems long-term. The report embraces comprehensive tax reform to make the system more streamlined, understandable, equitable and competitive while also generating adequate revenues."

Another extra-Congressional body? America's elected leaders can't find the will or means to do their job.

The race is on to the lowest global common denominator on taxes, worker pay/benefits, and publicly funded retirement programs. As employers and the government do less, that leaves the individual paying more. Who is ready for it?

The Bipartisan Policy Center was started in 2007 by ormer U.S. Senate Majority Leaders Howard Baker, Tom Daschle, Bob Dole, and George Mitchel. It utilizes principled compromise, when it is not employing compromised principles, like working for lobbying firm Alston & Bird but not declaring oneself a lobbyist.

A look at the contributors to the analysis reveals:

The policy recommendations in "Drowning in Red Ink" were gathered from the insight and comments of the following budget experts who served on the speakers panel of the BPC symposium: U.S. Majority Leader Steny Hoyer; former Congressional Budget Office Director Robert Reischauer, President of the Urban Institute; former CBO Director Douglas Holtz-Eakin, President of DHEConsulting LLC; former Senate Budget Committee Staff Director G. William Hoagland, now Vice President for Public Policy at CIGNA; former Assistant Secretary of the Treasury, C. Fred Bergsten, Director of the Peterson Institute for International Economics; and former Comptroller General of the U.S. David Walker, now President and CEO of the Peter G. Peterson Foundation.

Pete Peterson made billions from his private equity deals. The Bush tax breaks and preferred taxation on carried interest were boons to his personal finances. He leads the call to cut entitlements, while holding the line on taxes for corporations and the wealthy. Immediate cuts to Medicare and Social Security make sense to this group. What about the electorate?

Monday, August 10, 2009

The last time Mike Conaway held an open house at ASU, the Congressman pleaded for some West Texas hospitality. He heard from upset U.S. Veterans with serious concerns about VA health care. Fellow Republicans were unhappy with the direction of the party under Mike's good friend, President George W. Bush. He returns to the site of his excoriation, with health care reform as the topic.

How might Rep. Conaway weigh in on health reform? His lifetime PAC contributions are 90% from businesses. Businesses can give to Mike in multiple ways. They donate directly to his campaign or to Mike's political action committee, CONA PAC. A number of DC lobbying firms, Dutko Worldwide and Olgivy Government Relations, gave to Conaway's PAC in 2008.

CONA PAC launders money to other Republican candidates. His fundraising went from $36,000 in 2006 to $125,000 in 2008. That pales relative to Conaway's campaign contributions, over $4 million in his relative short, frequently unopposed career.

How have health care firm's supported Rep. Conaway? Mike's health insurance supporters include WellPoint and Humana. Private equity owned U.S. Oncology gave big money to his campaign. If money determines the stance, Conaway will be a for-profit health care supporter.

As for the appearance of impropriety, the Albertine brothers and Albertine Enterprises appear frequently on Conaway's donor list.

John (aka Jack) Albertine lives in Fredericksburg, but not the Texas version. His home is in Virginia. Jack recently made the business news as Chairman of Integral Systems. The firm's CEO resigned after a quarterly loss, but the bigger news was an SEC violation. The Securities and Exchange Commission charged Integral leaders with fraudulently concealing for more than seven years the identity and involvement of a convicted securities fraud felon in the company's top management. The complaint names Steven R. Chamberlain, former CEO; Elaine M. Brown, former CFO; and Gary A. Prince, the undisclosed felon, according to the SEC.

Integral Systems could've used Mike Conaway's CPA skills. It announced Dec. 10 that its unaudited financial statements could no longer be relied on due to accounting errors. Integral said about $10 million in revenues would have to be deferred as a result of the company's audit.

Representative Conaway runs with a dirty crowd. We knew that from the National Republican Congressional Committee's six year embezzlement of nearly $1 million in donor funds. It took Mike a full year as head of the Audit Committee to catch on to Chris Ward's looting. The story changed so many times, but isn't that political spin? Likely what the public will hear this Tuesday from 4:30 to 5:30 pm at Angelo State on health care.

Mike's word is as good as his record, which seems rather spotty. On health care Conaway's been AWOL for a district with low unemployment and a higher than Texas average of uninsureds. Texas happens to be the worst in the country on that measure.

How will Conaway be received in his second ASU open house? Will it be excoriation redux? If people paying attention show up, Mike will need more than his usual goose poop slickness.

Sunday, August 09, 2009

Health insurers quietly targeted conservative Democrats to get their way in health reform. While the "Blue Dogged" House passed three health care bills, the issue is stuck in the Senate. Reform is held up by "moderate" Democrats, better known as Corporacrats. Baucus, Bayh, Conrad, Nelson I, Nelson II, and the Senators from the Walmart state gum up the works to benefit For-Proifteers. Meanwhile, the White House and enforcer Rahm Emanuel defend Corporacrats from ads by progressive groups.

The BusinessWeek piece is titled "Health Insurers Have Already Won." It states:

The likely victors are insurance giants such as UnitedHealth Group (UNH), Aetna (AET), and WellPoint (WLP).

WellPoint's Board includes Susan Bayh and William H.T. Bush. Susan is the wife of Indiana Senator Evan Bayh. Flipping her stock options grossed the Bayh family over $1.5 million the last five years. William H.T. Bush is known as "Uncle Bucky" to President George W. who never saw an insurance company he didn't like.

UnitedHealth's board includes Gail Wilensky, an expert who testified before Max Baucus' Senate Finance Committee. She failed to disclose her board role or her $20 million in health care stock holdings in her public testimony.

The industry has already accomplished its main goal of at least curbing, and maybe blocking altogether, any new publicly administered insurance program that could grab market share from the corporations that dominate the business.

The story details a meeting between UnitedHealth CEO Steve Hemsley and Senator Kent Conrad and the introduction of co-ops. Conrad denies Hemsley was the source of his Judas bait & switch, but it is front and center in the Senate Finance Committee's plans. The sausage making update finds:

The several competing bills pending in Congress would guarantee all Americans access to health coverage, addressing the plight of the 47 million who are now uninsured. Congress plans to achieve that by expanding Medicaid, the government program for the poor and disabled; requiring insurers to accept all applicants regardless of their health; and mandating that everyone purchase coverage.

State governors say they can't afford to take on more Medicaid enrollees. Many states are cutting Medicaid eligibility and uncovering services, i.e., shifting costs back on low income patients. Even in "covering more people", risk is being shifted back to the individual through higher deductibles, greater co-pays and fewer services covered. It's a back door way of dumping insurance company risk, a familiar refrain for the For-Profiteers. The BW piece drives this home:

In late spring, the Finance Committee was assuming a 76% reimbursement rate on average, meaning consumers would be responsible for paying the remaining 24% of their medical bills, in addition to their insurance premiums. Stevens and his UnitedHealth colleagues urged a more industry-friendly ratio. Subsequently the committee reduced the reimbursement figure to 65%, suggesting a 35% contribution by consumers—more in line with what the big insurer wants. The final figures are still being debated.

Unless there is catastrophic stop-loss coverage, medical bankruptcies will remain common. The public is being lied to on so many fronts. President Obama urgently mentions 14,000 people losing insurance coverage every day. Yet, expanded coverage for the uninsured won't begin until 2013. Republicans and their scare tactics regarding living wills, a twenty year old patient right, is just as disingenuous. The public is not being told the truth.

Both political franchises wish to abdicate their responsibilities for leadership by delegating to a MedPac, an extra-legislative body. Elected leaders don't have the cohones to do their job. Instead they pander to their corporate sponsors, many with disturbing connections. Page 4 of the BW article mentions UnitedHealth's huge stock option backdating scandal, Arthur Anderson (Enron's partner in accounting crime), Fannie Mae (also guilty of accounting shenanigans and sucking up billions in taxpayer bailout), and ethically challenged Tom Daschle of Alston & Bird (a DC lobbying firm with Tom Scully--architect of Big Pharma's Medicare Prescription Plan). Feel better?

Corporate sponsored health care deform is on the way. Expect to pay more on behalf of the For-Profiteers. Thank your Congressional lackey by throwing him/her out of office in 2010. Judge President Obama by his actions, not words.